Journal of Pharmaceutical Care

Not applicable.

Background: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are among the most common mental disorders contributing to sleep disturbance. Given the decline in sleep quality of these patients, improving sleep may be addressed alongside other treatment strategies. This study evaluated the effect of melatonin on improving sleep quality in patients who were diagnosed with MDD or GAD.
Methods: Seventy-eight patients diagnosed with MDD or GAD were randomly assigned to two groups, including the intervention group, which received oral melatonin 3 mg daily for four weeks and the control group, which received only placebo. Assessments were made by the Groningen Sleep Quality Scale (GSQS) and Pittsburgh Sleep Quality Index (PSQI) questionnaire at the beginning and after four weeks using SPSS software.
Results: The mean age of patients was 38.78±14.12 years. There was no significant difference between the two groups in terms of demographic data. According to the analysis, although the change in GSQS scores between the placebo and melatonin groups was not significantly different from baseline scores, the difference in PSQI scores before and after the use of melatonin was significant (P=0.01). There was also a significant difference regarding the GSQS score between the two groups before and after the intervention (P=0.04).
Conclusion: The present study illustrated that melatonin use for one month could improve the quality of sleep among MDD and patients with GAD to some degree; however, according to the PSQI and GSQS scoring, there is no credible evidence that shows a significant improvement in the sleep quality of our study population.

Background: Surgical antimicrobial prophylaxis (SAP) is critical for preventing surgical site infections (SSIs). However, inappropriate use of SAP contributes to antibiotic resistance. This study evaluated compliance with the American Society of Health-System Pharmacists (ASHP) SAP guidelines at a tertiary care hospital in India and assessed the implications for SSI prevention and antimicrobial stewardship.

Methods: A prospective observational study was conducted from June–August 2024, analyzing 95 surgical cases. SAP practices were audited against the ASHP guidelines for five parameters: indication, antibiotic choice, timing (pre-incision 30–60 min), route (IV), and duration (< 24h postoperatively). Data were collected systematically from electronic records and analyzed for compliance rates.

Results: Overall, adherence to the SAP guidelines was 99.4%, and compliance was highest for antibiotic selection (100%), dosing (100%), and postoperative duration (100%). Preoperative timing compliance was 97%, while 6% received unjustified prophylaxis. Elective surgeries (67%) predominated, with ceftriaxone (31%) and cefuroxime (31%) being the most prescribed antibiotics. Moreover, a significant gender disparity was observed, mostly (76%) in male patients.

Conclusion: Near-perfect compliance with the SAP guidelines is achievable in resource-limited settings, demonstrating that strict adherence to the ASHP guidelines minimizes unnecessary antibiotic use while maintaining SSI prevention efficacy. The 6% unjustified prophylaxis rate highlights an opportunity for stewardship refinement. These findings provide a replicable model for optimizing SAP in global surgical practice.

Background: The global population of older adults is increasing. Considering the differences in the pharmacokinetics and pharmacodynamics of medications in this population, some medications are considered potentially inappropriate. This study examined the pre-admission use of potentially inappropriate medications (PIM) in hospitalized geriatric patients and investigated drug-drug interactions (DDI) among these individuals.

Methods: This cross-sectional study was conducted at a tertiary care teaching hospital in Tehran, Iran. The Beers criteria were utilized to identify PIM. All medications taken by eligible patients prior to admission, including over-the-counter drugs, herbal remedies, and dietary supplements, were documented along with the patients’ diseases and health conditions.

Results: Among the patients, 56.8% were men, and their ages ranged from 65 to 95 years. We found that 39% of patients received at least one PIM. Out of 1406 pre-admission medications, 132 (9.3%) and 26 (1.84%) were classified as PIM based on drug-to-avoid and drug-disease criteria, respectively. In 4.4% of patients, selected DDI was noted, and polypharmacy was observed in 151 (60.4%) patients. The most frequent PIM in drug-to-avoid criteria belonged to the nervous system (46.46%), followed by the alimentary tract and metabolism (26.1%). Based on the drug-to-avoid and drug-disease criteria, the average number of underlying diseases in patients with PIM was significantly higher than those without PIM (p-value = 0.014 and p-value = 0.001, respectively).

Conclusion: The prevalence of PIM in the present study was similar to that of previous studies conducted with the same criteria and setting. Polypharmacy and a higher number of comorbidities significantly increased PIM utilization. With the growing elderly population, healthcare providers must be more vigilant about the varied medication needs of this population.

  Background: The present study aimed to evaluate patient knowledge, attitudes, and expectations concerning over-the-counter (OTC) medications and to investigate the impact of demographic characteristics on patients’ choices when buying these medications. Gaining insight into these elements is essential for encouraging the safe use of OTC drugs and mitigating the potential dangers linked to their improper use or misinterpretation.

Methods: This descriptive cross-sectional study investigated Tehran community pharmacies between April 2022 and March 2023. A validated 25-item questionnaire was distributed to 384 participants, resulting in 306 complete responses for analysis. Statistical analysis was performed using SPSS version 22. Pearson correlation (r), independent-samples t-test, and one-way analysis of variance (ANOVA) were employed, with statistical significance set at P < 0.05.

Results: In a study investigating OTC medication information, pharmacists were identified as the leading source for most participants (71.6%). The research revealed moderate mean scores for participant knowledge (3.3 ± 0.6) and attitudes (3.3 ± 0.5), while relatively high expectations (3.8 ± 0.7). Further analysis indicated a significant association between a participant’s education level and their knowledge (P = 0.001) and expectations (P = 0.022) concerning OTC medications. Participants aged 45 and older demonstrated significantly higher expectations (P = 0.015). However, no significant differences were observed in knowledge or attitudes based on gender, the presence of chronic illness, or regular medication use.

Conclusion: These results highlight significant knowledge deficits, especially concerning the appropriate dosage and administration of medications, even though pharmacists are the primary source of such information. Consequently, there is a clear need for public health education campaigns specifically designed for older adults and individuals with lower levels of education. Furthermore, pharmacist-led interventions should be enhanced to better reconcile patient expectations with evidence-based pharmaceutical practices.

Background: Resistance to antibiotics is increasing. Hospital overuse of antibiotics is a significant contributor to antibiotic resistance. A rational use of antibiotics is necessary to optimize the outcome of critically ill patients. The study aimed to examine the utilization pattern of antibiotics in the intensive care units (ICUs) of a tertiary care public hospital.
Methods: This observational study was conducted over eight months in the medical ICU (MICU), surgical ICU (SICU), and trauma ICU (TICU). Data regarding prescribed antibiotics, including name, content, dose, route of administration, and duration of treatment, were used to describe the pattern and estimate the consumption. The defined daily dose (DDD)/100 bed-days of each prescribed antibiotic was calculated.
Results: The three most frequently used antibiotics in all the ICUs were piperacillin + tazobactam (107 patients), Meropenem (74 patients), and Metronidazole (72 patients). The total utilization of antibiotics was 46.94, 53.91, and 38.84 DDD/100 bed-days in the TICU, SICU, and MICU wards, respectively. Antibiotics with the highest utilization (DDD/100 bed-days) in each ward were meropenem (13.47) in the SICU, piperacillin + tazobactam (10.64) in the TICU, and ceftriaxone (9.49) in the MICU.
Conclusion: The present study results indicated that the percentage share of different antibiotic drugs varied according to the type of ICU and disease. Penicillin combinations, cephalosporin, and carbapenems were the most commonly used antibiotic groups in all ICUs. High consumption of broad-spectrum antibiotics underscores the importance of stewardship programs to overcome the growing resistance to available effective antibiotics in ICUs.

Background: This review elucidates the multifaceted therapeutic effects of Juglans L. (J.), a medicinal plant with a rich heritage in traditional medicine and promising potential in modern healthcare.
Methods: A narrative review was conducted focusing on randomized clinical trials (RCTs) published between 2000 and 2023. A comprehensive literature search was performed in databases including PubMed, Scopus, ClinicalKey, Google Scholar, and the Persian Scientific Information Database. The keywords “Juglans” and “J.” were used. Only human RCTs evaluating various parts of the plant (fruit, leaves, bark, internal septum) were included. Non-human and non-randomized studies were excluded.
Results: The findings reveal that while some trials report significant health benefits of J., others show minimal or no effects, suggesting the importance of personalized approaches in clinical application.
Conclusion: This review underscores the growing role of herbal medicine in preventive care and as a complement to standard treatments. Further studies are needed to clarify its mechanisms of action, determine optimal dosing, and evaluate long-term safety and efficacy. As global interest in natural remedies rises, J. stands out as a promising candidate in both preventive and therapeutic contexts

Letrozole, a nonsteroidal aromatase inhibitor, is the adjuvant endocrine treatment for postmenopausal women
with estrogen receptor-positive breast cancer. Erythema nodosum (EN) is a rare skin adverse effect of letrozole
which has been previously reported in a few case reports. We report a new case of EN-induced by letrozole in
a 63-year-old Iranian woman with left breast cancer who was estrogen receptor-positive. Physical examination
and laboratory findings were consistent with EN. Manifestations resolved following discontinuation of
letrozole and treatment with oral prednisolone. This case highlights EN as a potential adverse effect of letrozole.
Clinicians should be aware of this rare but significant reaction, as early recognition and discontinuation of the
offending agent can lead to complete resolution of symptoms.